Background Bilateral sacroiliitis at presentation usually prompts a search for an inflammatory disease with the usual suspect being the spondyloarthritides. Infectious diseases and neoplasias, as a rule, affect this joint unilaterally. A worldwide resurgence in tuberculosis and resultant improvement in diagnostic modalities has contributed to unmasking this great masquerader at unusual sites.We present one case.
Results A 42 year old female, presented with low back and buttock pain of 3 months duration, along with significant morning stiffness. There was no evidence of other articular or extra-articular manifestations. On the basis of clinical presentation, raised acute phase reactants (APRs) and radiographic bilateral sacroiliitis,she was diagnosed as a case of spondyloarthritis and initiated on daily non steroidal anti-inflammatory drugs (NSAIDs).
She reported to our referral center with persistent symptoms despite four weeks of NSAIDs. On examination, she was afebrile, with bilateral sacroiliac joint tenderness and painful spinal movements. Investigations revealed normocytic anaemia with elevated APRs, positive Tuberculin test (18mm) and negative Human Leucocyte Antigen B27. Chest radiograph and abdominal ultrasound was normal. Magnetic resonance imaging of the sacroiliac (SI) joints revealed bilateral effusion with multiple abscesses in gluteal muscles.
Polymerase chain reaction for Mycobacterium tuberculosis was positive on computed tomography guided needle aspirate of the SI joint. Patient showed clinical improvement and complete radiographic resolution of abscesses after two months of conventional four drug anti tubercular therapy.
Conclusions Tuberculosis of bilateral sacroiliac joints is uncommon with only isolated case reports. There is usually a lesion in the lumbar spine from where a psoas abscess spreads to involve both sacroiliac joints, however no such vertebral lesions were discernable in our case. Diagnosis is usually delayed because of deep pelvic location and absence of clinically discernable joint inflammation. Lack of awareness of the possibility of bilateral SI joint involvement in this infection often leads to diagnostic delay, prolonged management as spondyloarthritis and consequent increased morbidity.
Seddon HJ, Strange FG. Sacroiliac tuberculosis. Br J Surg 1940; 28:193–221
Disclosure of Interest None declared